Vascular malformations
Vascular malformations are congenital (occurring at birth) vascular (pertaining to blood vessels) anomalies. They occur due to an abnormality in the development of blood vessels in the foetus, leading to the formation of clusters of blood vessels that commonly appear as lesions on the skin. They can also form in mucous membranes, such as in the mouth or eyelids, and in muscles or internal organs like the brain and heart.
Types
Vascular malformations can be classified depending on the blood vessel affected:
- Capillary malformations (only capillaries)
- Lymphatic malformations (only lymphatic vessels) are the most difficult to treat
- Venous malformations (only veins) are the most common vascular malformation
- Arteriovenous malformations (arteries that flow directly into veins, without capillaries in between) have a high rate of recurrence and can be life-threatening
- Combined vascular malformations (combination of two or more types of vessels)
Vascular malformations form in small vessels but not in large vessels or the heart.
Vascular malformations are further divided depending on the amount of blood flow within the lesion:
- Low flow (capillary, venous and lymphatic malformations)
- High flow (arterial and arterio-venous malformations)
- Mixed (capillary-lymphatico-arteriovenous malformations, capillary-venous, etc.)
Symptoms
Vascular malformations are usually visible at birth as soft, lumpy coloured marks on the skin, but some can develop during childhood and teenage years. They may grow in size as the child grows and puts on weight, when the area is injured, or when hormone levels rise during puberty, pregnancy or with the use of contraceptive pills. The symptoms depend on the size and location of the malformation, and may include:
- Pain
- Swelling due to enlargement of the abnormal blood vessels
- Loss of function
- Loss of mobility when present on the arm or leg
- Shortness of breath and tiredness with activity
- Lesion may feel warm, tender, bleed or bruise easily
- Leakage of lymph fluid and recurrent skin infections
- Formation of clots that could travel to lungs and other body parts, leading to brain abscess or stroke
Diagnosis
Vascular malformations may be diagnosed by a thorough physical examination and through imaging tests that include magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography. Your child’s doctor may also recommend an angiography, in which blood vessels are viewed by injecting a dye through them and taking images using X-rays.
Treatment
Vascular malformations that do not cause any problems are carefully observed. Your child’s doctor may also recommend the use of compression garments to stop blood pooling, promote blood circulation and relieve discomfort at swollen areas. Medication may be prescribed to prevent blood clot formation. Your child’s doctor may suggest other therapeutic procedures like:
- Sclerotherapy: injecting medicine into the blood vessel to shrink it.
- Laser therapy: directing laser beams (high-energy heat and light) on superficial lesions to destroy the abnormal blood vessels
- Embolisation: less invasive treatment where your surgeon completely blocks abnormal blood vessels
- Surgery: surgical removal of deep malformations. Surgery may be combined with embolization for large lesions surrounded by vital nerves, muscles, bones or organs, to avoid damage to these tissues
- Stereotactic radiosurgery: delivery of focused radiation directly towards the malformation to destroy the abnormal blood vessels. Radio-surgery is used to treat small malformations that cannot be removed surgically or embolised
These treatments may be performed in combinations to alleviate the symptoms and improve your child’s quality of life.
